Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, And State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, And State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
Sleep Med Rev. 2022 Oct;65:101687. doi: 10.1016/j.smrv.2022.101687. Epub 2022 Aug 12.
This study aims to explore the comparative efficacy and acceptability of psychotherapies, pharmacotherapies, and their combinations for insomnia. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, and ClinicalTrials.gov were searched for randomized clinical trials (RCTs) examining the comparative efficacy in which a psychotherapy and a pharmacotherapy for insomnia were directly compared with each other, or in which a combination of psychotherapy and pharmacotherapy was compared with either alone. The analysis included data from 23 RCTs. In 18 of 23 studies, cognitive behavior therapy for insomnia (CBT-I) was the psychotherapy. At post-treatment, CBT-I showed higher subjective sleep efficiency (SE), and lower subjective wake time after sleep onset (WASO) and insomnia severity index (ISI) score. Compared with CBT-I plus pharmacotherapy, pharmacotherapy showed lower subjective SE, and higher subjective sleep latency (SL), PSG measured SL, subjective WASO, and ISI score. Overall, the findings derived from post-treatment data suggested that CBT-I is more beneficial in treating insomnia compared with pharmacotherapy. CBT-I combined with pharmacotherapy is beneficial in improving some sleep parameters (i.e., subjective SE, SL, WASO, and PSG measured SL) compared with pharmacotherapy alone. Daily clinical decisions should consider these findings on the relative efficacy of the principal approaches to insomnia treatment.
本研究旨在探讨失眠的心理治疗、药物治疗及其联合治疗的疗效和可接受性。我们检索了 MEDLINE、EMBASE、Cochrane 对照试验中心注册库、PsycINFO、CINAHL 和 ClinicalTrials.gov，以寻找直接比较心理治疗和药物治疗对失眠疗效的随机临床试验（RCT），或比较心理治疗和药物治疗联合治疗与单独治疗的疗效的 RCT。该分析纳入了 23 项 RCT 的数据。在 23 项研究中的 18 项中，失眠认知行为疗法（CBT-I）是心理治疗。在治疗后，CBT-I 显示出更高的主观睡眠效率（SE），更低的主观入睡后醒来时间（WASO）和失眠严重程度指数（ISI）评分。与 CBT-I 联合药物治疗相比，药物治疗显示出更低的主观 SE，以及更高的主观睡眠潜伏期（SL）、PSG 测量的 SL、主观 WASO 和 ISI 评分。总体而言，来自治疗后数据的结果表明，与药物治疗相比，CBT-I 更有益于治疗失眠。与单独药物治疗相比，CBT-I 联合药物治疗在改善某些睡眠参数（即主观 SE、SL、WASO 和 PSG 测量的 SL）方面更有益。日常临床决策应考虑这些关于失眠治疗主要方法相对疗效的发现。
